A need for evidence to guide treatment recommendation for women with chronic venous disease during childbearing years

Abstract

Pregnancy is a well-known and important risk factor for the development of primary and recurrent varicose veins. 1,2 The reasons for this are secondary to hormonal and mechanical issues, including the effect of progesterone on the veins along with the compressive effect of the foetus causing increased venous pressure in the leg. 3 Pregnant women with varicose veins have exacerbation of their venous symptoms during this period with significant problems including leg oedema (in up to 80% of women) along with night cramps, numbness, tingling, itching and throbbing with additional complication of superficial and deep vein thrombosis and pulmonary embolism. 4,5 In general, pregnant women with symptomatic varicose veins are offered compression stockings either class (14-17mmHg) and (18-24mmHg) in degree or advised to elevate their legs as much as possible. 6-8 This can be difficult in warmer climates and when patients are in late stages of their pregnancy. Symptoms tend to worsen as the pregnancy progresses with increasing leg oedema. It is known that the majority of these symptoms do improve post gestation, usually within three months. 9 However, the rate of compliance of stockings is poor with up to 40% either refusing to wear stockings or non-compliant during their pregnancy. 6 Controversy exists as to whether patients should be advised to have venous intervention between pregnancies or wait until they have completed their family. The reason for advocating delay was a perceived higher recurrence rate following open surgery (20-40%) which would have then required redo-surgery in the groin with its associated morbidity. 10 However, with emerging technologies, it is possible to now treat recurrent veins with minimally invasive techniques, thus reducing the morbidity associated with recurrent groin surgery. It is worth noting at this point that